Sleep Apnea in the Central Region: Identifying and Managing It
Central sleep apnea (CSA) is a sleep disorder that affects a significant portion of the adult population, with estimates suggesting it affects between 9-38%. Unlike its more common counterpart, obstructive sleep apnea, CSA is not caused by physical blockages in the airway but rather by a failure in the brainstem's signalling to the respiratory muscles.
The root causes of CSA can be diverse, ranging from brainstem dysfunction to underlying medical conditions such as heart failure, stroke, or neurological disorders like Parkinson's and amyotrophic lateral sclerosis (ALS). In some cases, CSA may also be triggered by the effects of certain medications or diseases that impact brainstem signalling.
The symptoms of CSA can be quite distressing, with individuals experiencing excessive daytime tiredness or sleepiness, poor quality or fragmented sleep, difficulty concentrating or paying attention, morning headaches, chest discomfort at night, waking up with shortness of breath, abnormal breathing patterns, and snoring (though this is more commonly associated with obstructive sleep apnea).
Fortunately, CSA can be treated, and the primary approach is to address the underlying causes. This may involve treating heart disease, managing neurological disorders, adjusting medications, or controlling contributing factors such as heart failure symptoms, stroke rehabilitation, and neurological disease progression.
Specialized versions of Continuous Positive Airway Pressure (CPAP) machines or adaptive servo-ventilation (ASV) may also be used to stabilise breathing during sleep. Oxygen therapy at night might also be recommended to maintain adequate oxygen levels. In some cases, respiratory stimulants may be prescribed to improve breathing drive, although their use must be carefully managed.
It's important to note that CPAP may not be effective in people with central sleep apnea, and an alternative treatment option should be sought if it fails to improve symptoms. Adaptive servo-ventilation is a less invasive way to deliver air to the body, continuously monitoring the person's breathing to help identify and deliver the ideal air pressure to relieve symptoms.
In some cases, CSA may occur without an underlying cause, known as idiopathic central sleep apnea. However, it can also arise from other conditions, such as late-stage kidney disease, severe obesity, or stroke.
Properly treating the underlying cause of CSA can stop or greatly reduce the apnea itself in many cases. In some instances, mixed sleep apnea, a combination of obstructive and central sleep apnea, may be present, requiring a tailored treatment approach.
Phrenic nerve stimulation, which stimulates the major nerve that controls the diaphragm and the process of breathing itself during sleep, can control many central sleep apnea symptoms. Treatment-emergent sleep apnea may occur in people who use CPAP machines for obstructive sleep apnea, requiring continuous treatment or a change in treatment.
The outlook for central sleep apnea depends on a number of factors, including how well the person adheres to their treatment plan and how effectively doctors can treat any underlying conditions. By understanding CSA and seeking appropriate treatment, individuals can improve their sleep quality and reduce their risk of other health issues.
- Central sleep apnea (CSA) can be triggered by the effects of certain medications or diseases that impact brainstem signalling, as well as underlying medical conditions such as heart failure, stroke, or neurological disorders like Parkinson's and amyotrophic lateral sclerosis (ALS).
- CSA may occur without an underlying cause, known as idiopathic central sleep apnea, but it can also arise from other conditions, such as late-stage kidney disease, severe obesity, or stroke.
- Treating the underlying cause of CSA can stop or greatly reduce the apnea itself in many cases, and specialized versions of Continuous Positive Airway Pressure (CPAP) machines or adaptive servo-ventilation (ASV) may be used to stabilize breathing during sleep.
- Proper treatment of CSA can improve sleep quality and reduce the risk of other health issues, and by understanding CSA and seeking appropriate treatment, individuals can also reduce the symptoms associated with CSA, such as excessive daytime tiredness or sleepiness, poor quality or fragmented sleep, and snoring (though this is more commonly associated with obstructive sleep apnea).
